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Position Summary
Aetna Better Health is hiring for a Case Management Coordinator (CMC) for the Cumberland region. A Case Management Coordinator (CMC) utilizes critical thinking and professional judgment to support the case management process, in order to facilitate and maintain improved healthcare outcomes for members by providing advocacy, collaboration coordination, support and education for members through the use of care management tools and resources.

This is a telework position. This position is assigned to theCumberland Region. Candidate must reside in one of the following counties: Green, Taylor, Adair, Cumberland, Clinton, Russell, Casey, Pulaski, Wayne, McCreary, Rockcastle, Jackson, Laurel, Whitley, Knox, Clay, Bell, or Harlan counties.
 

Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm CST, is required. We are serving the needs of children and families that may require working after school, after work, etc.

Evaluation of Members:
- Through the use of care management assessments and information/data review, recommends an approach to resolving care needs maintaining optimal health and well-being by evaluating member’s benefit plan and available internal and external programs/services.
- Identifies high risk factors and service needs that may impact member outcomes and implements early and proactive support interventions.
- Coordinates and implements Wellness care plan activities and monitors member care needs.
Enhancement of Medical Appropriateness and Quality of Care:
- Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
- Identifies and escalates quality of care issues through established channels.
- Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
- Helps member actively and knowledgably participate with their provider in healthcare decision-making.
Monitoring, Evaluation and Documentation of Care:
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

- Candidate must reside in the Cumberland region: Green, Taylor, Adair, Casey, Cumberland, Russell, Clinton, Wayne, Pulaski, McCreary, Whitley, Laurel, Jackson, Rockcastle, Jackson, Knox, Clay, Bell, or Harlancounties in KY.

- Ability to travel up to 5% of the time
- Minimum 6 months experience in Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services or evidence-based practices applicable to the Kentucky SKY populations, is required.
- Minimum 1 year of experience required in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
- Minimum 1 year of experience in MS Office Suite applications, including Word and Excel.

Education

Pay Range

The typical pay range for this role is:

$21.10 - $36.78

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 12/30/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.